Title Page

  • Ladder Reference Number:

  • Client / Site

  • Conducted on

  • Inspector

  • Stepladder

  • Size (FT.)

  • Type

  • Steps: Loose, Cracked, Bent, or Missing

  • Rails: Cracked, Bent, Split, or Frayed Rail Shields

  • Labels: Missing or Not Readable

  • Pail Shelf: Loose, Bent, Missing, or Broken

  • Top: Cracked, Loose, or Missing<br>

  • Spreader: Loose, Bent, or Broken

  • General: Rust, Corrosion, or Loose

  • Other: Bracing, Shoes, Rivets

  • ACTIONS:

  • Extension Ladder

  • Size (FT.)

  • Type

  • Rungs: Loose, Cracked, Bent, or Missing

  • Rails: Cracked, Bent, Split, or Frayed

  • Labels: Missing or Not Readable

  • Rung Locks: Loose, Bent, Missing, or Broken

  • Hardware: Loose, Missing, or Broken

  • Shoes: Worn, Broken, or Missing

  • Rope/Pulley: Loose, Bent, or Broken

  • Other: Bracing Rivets

  • General: Rust, Corrosion, or Loose

  • ACTIONS:

  • Specialty Ladder

  • Model Number:

  • Type

  • Steps/ Rungs: Loose, Cracked, Bent, or Missing

  • Rails: Cracked, Bent, Split, or Frayed

  • Labels: Missing or Not Readable

  • Hardware: Loose, Missing, or Broken

  • Fasteners: Rust, Corrosion, Loose, or Missing

  • Top: Cracked, Loose, or Missing<br>

  • Spreader: Loose, Bent, or Broken

  • Outriggers: Missing, Rust, Corrosion, or Loose for scaffolding

  • General: Rust, Corrosion, or Loose

  • Hinges: Loose, Bent, or Missing

  • Locks: Loose, Bent, Broken, or Missing

  • Bracing- Front/ Rear: Loose, Bent, Broken, or Missing

  • Rail Shield: Missing or Loose

  • Casters: Rust, Corrosion, or Loose for scaffolding

  • ACTIONS:

  • Inspector Signature

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